Cross-national patterns of probable complex PTSD in post-communist Europe: A network analysis of five countries

Background: Central and Eastern European (CEE) populations share historical challenges, including communist-era governance and post-transition changes, yet cross-national comparisons of trauma and stress related symptoms remain limited. This study examined trauma exposure, post-traumatic stress disorder (PTSD), and Complex PTSD (CPTSD) prevalence and symptom networks across five CEE countries. Methods: A cross-sectional study of 5070 adults from five CEE countries assessed trauma exposure using the International Trauma Exposure Measure (ITEM). Of these, 4012 (79.1%) reporting trauma completed the International Trauma Questionnaire (ITQ). Cross-national comparisons used chi-square and ANOVA. Network analysis identified symptom centrality and structural differences using Gaussian Graphical Models with comparison tests. Results: Trauma exposure patterns were similar across countries (η²=0.003–0.009), but disorder prevalence differed substantially. CPTSD consistently exceeded PTSD, with Poland showing highest rates (CPTSD: 23.6%, PTSD: 14.4%). Network structures were broadly comparable, with Self-Organization symptoms, particularly negative self-concept, most central. Czech Republic and Slovakia uniquely showed additional central PTSD symptoms. Structural differences were most pronounced involving these countries. Bridge symptoms (startle response, affective dysregulation) were consistent cross-nationally. Conclusions: CEE countries demonstrate distinct profiles with CPTSD predominating. Country-specific symptom networks suggest tailored interventions targeting DSO symptoms in most countries, while also addressing PTSD symptoms in Czech Republic and Slovakia. Findings support the ICD-11 PTSD/CPTSD distinction and highlight the importance of country-specific interventions.